“The spiritual journeys of those living with mental health challenges, wrapped in webs of clinical complexity, offer profound insight if we learn to listen deeply to their stories, rather than stigmatize and label them. In this remarkable book, John Swinton helps us unravel the tangled threads of psychological definitions, biological explanations, psychotropic medications, and the authentic faith experiences of Christian disciples, sharing the gifts and courageous journeys of these souls. With well-researched psychological insight and theological wisdom, this book should be in the library of every pastor, and at the bedside of anyone seeking to understand how God’s grace can weave through the disturbing pathways of those living with mental health challenges.” —Wesley Granberg-Michaelson author of Without Oars: Casting Off into a Life of Pilgrimage “Moving beyond the tired old language of ‘illness’ and ‘battles,’ Swinton invites us into the mental health journeys of a rich variety of people who speak in their own words, medically, theologically, and honestly. Focusing more on dignity than diagnosis, he shows that God works in all things, and healing comes in many forms. Sweeping aside the false dichotomy between science and faith, Swinton’s readers are invited into a more nuanced theological world in which they may find themselves unexpectedly and lovingly represented. This is also a rich resource for pastors, teachers, parents and anyone else who has a stake in brain health, because, in the end, who doesn’t?” — Lillian Daniel author of Tired of Apologizing for a Church I Don’t Belong To “Finding Jesus in the Storm first of all listens deeply, or, as John Swinton says, ‘thickly,’ to people with mental health challenges and helps a reader see, broaden, and reconstruct both the ways that people of faith might walk with people with mental challenges as well as help people with mental health challenges explore the spiritual dimensions of their own journey. As someone who has both worked with others and my own mental health challenges, this felt very real. Using insights from psychology, sociology, theology, and other disciplines, Swinton once again breaks past multiple forms of stigma and unexamined assumptions to help readers enter a space where we can once again see each other as children of God— pilgrims—doing the best we can to live into the embrace of God’s love.” — Bill Gaventa author of Disability and Spirituality: Recovering Wholeness “With the nuanced perspective of a theologian and ordained minister who is also a psychiatric nurse, John Swinton offers here a rich ‘theology that drops down into the heart’ for people who live with mental health challenges. Refusing to reduce people to their neurons or to the labels that are assigned to them, he introduces us to the complex, lived experiences of real people as they live, wonder, worship, and love amid mental health challenges. In their close-to-the-ground stories, we find not only lament and loss but also joy, kindness, and grace. Finding Jesus in the Storm will challenge and bless all who care about the relationship between mental health and the life of Christian faith.” — Warren Kinghorn Duke University Medical Center and Duke Divinity School
“In this remarkable book, John Swinton not only takes the spiritual lives of those living with mental health challenges seriously, he weaves together a beautiful, reflective theology of the cross and resurrection in the light of these experiences. This important and timely book is a must read for all of us who seek to live faithfully in the world today.” — Paula Gooder author of Body: A Biblical Spirituality for the Whole Person “Finding Jesus in the Storm is a masterful, wise, clear, and compassionate look at the experience of those struggling with mental health challenges such as depression, bipolar disorder, and schizophrenia, and the thin ways these are often described by mental health professionals, Western culture, and the church. Helped by refreshing philosophical insights, we are invited to listen to thicker descriptions of who these people are in relation to a theological, as well as a clinical horizon, and to better understand biblical healing—finding joy in Jesus while suffering. This book should be widely read.” — John R. Peteet, MD Harvard Medical School “John Swinton has listened well to Christians who have struggled with the unrelenting storms of severe mental health challenges. He has heard them tell of their experiences of the presence of God, and of the seeming absence of God, and of faith that grapples with the tensions between the two. Finding Jesus in the Storm provides a ‘thick’ description of Christian experiences of depression, schizophrenia, and bipolar disorder. Drawing on the author’s experiences as mental health nurse, minister, and practical theologian, these accounts are engaged in conversation with both professional and Christian perspectives, scanning the horizons of mental health care, Christian Scripture, tradition, and church life. This book provides a unique, and hard won, account of journeys through deeply troubled waters. It is essential reading for all who are dissatisfied with superficial and second-hand Christian accounts of mental illness.” — Chris C. H. Cook Durham University
Finding Jesus in the Storm The Spiritual Lives of Christians with Mental Health Challenges
John Swinton
William B. Eerdmans Publishing Company Grand Rapids, Michigan
Wm. B. Eerdmans Publishing Co. 4035 Park East Court SE, Grand Rapids, Michigan 49546 www.eerdmans.com © 2020 John Swinton All rights reserved Published 2020 Printed in the United States of America 26 25 24 23 22 21 20 1 2 3 4 5 6 7 ISBN 978-0-8028-7372-9 Library of Congress Cataloging-in-Publication Data Names: Swinton, John, 1957– author. Title: Finding Jesus in the storm : the spiritual lives of Christians with mental health challenges / John Swinton. Description: Grand Rapids, Michigan : William. B. Eerdmans Publishing Company, 2020. | Includes bibliographical references and index. | Summary: “Practical theology for Christians affected by mental health challenges”— Provided by publisher. Identifiers: LCCN 2020012147 | ISBN 9780802873729 Subjects: LCSH: Mental health—Religious aspects—Christianity. | People with mental disabilities—Religious life. Classification: LCC BT732.4 .S955 2020 | DDC 248.8/62—dc23 LC record available at https://lccn.loc.gov/2020012147
Unless noted otherwise, Scriptures taken from the Holy Bible, New International Version®, NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission of Zondervan. All rights reserved worldwide. www.zondervan .com The “NIV” and “New International Version” are trademarks registered in the United States Patent and Trademark Office by Biblica, Inc.™
To my good friend Allen Walker, for whom the storms became just a little too powerful
Contents
Acknowledgments
xi
Introduction: Life in All Its Fullness
1
Thick Descriptions
2
“Mental Illness” as a Journey
3
About the Book and Its Language
5
Part I: The Art of Description Chapter 1: Redescribing the World of “Mental Illness”
11
The Practice of Description
12
The Problem of Thin Descriptions
14
Stigma as Thin Description
15
Making Up Thin People: The Diagnostic and Statistical Manual of Mental Disorders (DSM) 17 Biology and the Thinning of Mental Health Challenges
25
The Thinning of Spirituality
32
Chapter 2: Resurrecting Phenomenology
38
The Death of Phenomenology
39
Developing a Phenomenological Attitude
41
Four Horizons: Creating a Thick Conversation around Severe Mental Health Challenges
46
vii
Contents
Part II: Redescribing Diagnosis Chapter 3: Taking Our Meds Faithfully
55
Diagnosis, Alienation, and Resignation
57
AÂ Bipolar Story
62
Part III: Redescribing Depression Chapter 4: Lament and Joy
71
Depression 74 Thickening Our Understanding of Depression
79
Thinking about Joy
80
Depression as Antifeeling
83
Chapter 5: Finding God in the Darkness
89
Orientation 91 Disorientation 92 Reorientation 102 Finding God in God’s Absence
110
Part IV: Hearing Voices Chapter 6: Understanding Psychosis
119
The Problem with Schizophrenia
120
Understanding Psychosis
125
Nuancing Our Understanding
132
Chapter 7: Hearing Voices
134
Hearing Voices
135
When God Talks Back
136
Hearing Voices across Cultures
137
viii
Contents What Makes the Difference?
142
A Pathogenic Culture
144
Chapter 8: A Strange Kind of Loneliness
151
Are Voices Inevitably Bad? A Strange Kind of Silence
154
Theological Implications
158
A Theology of Naming
159
Part V: Redescribing Bipolar Disorder Chapter 9: Bipolar Faith
165
The Biology of Spirituality
167
The Problem with Neurological Explanations: Moving beyond Neuromania
169
Chapter 10: Bipolar Disorder and the Nature of Suffering
175
Catherine’s Story
176
Epistemic Innocence: Medicating a Prophet
178
Rethinking Recovery: Creating a Context for Epistemic Justice
183
Repercussions: The Shadow Side of Spiritual Elation
185
Two Aspects of Suffering
190
The Suffering That Emerges from the Ascription of the Demonic
190
The Suffering That Emerges from Truth Telling
200
Sacrifice and Vocation
203
Conclusion: Redescribing Healing
205
Cultural Healing
207
Liturgical Healing
208
Biblical Healing
209
Theological Healing
211
Epistemic Healing and Epistemological Generosity
212
ix
Contents Testimonial Healing
213
Relational Healing
214
Appendix: Mental Health Resources
217
Bibliography
219
Index
231
x
Acknowledgments
There are many people I should thank in relation to this book. It has been a long time in the making, and it’s been a difficult journey. My family have as always been remarkably supportive and forgiving as I have complained, moaned, and wrestled with this book. They always saw the end point even when I could not. I’d like to thank my friend and colleague Warren Kinghorn for his wisdom and insight, Katie Cross for her thoughtfulness in commenting on a later draft of the book, Joy Allen for her comments on depression, and Hannah Waite for her deep and personal insights into the important issues that this book wrestles with. I am grateful to Uli Guthrie for her guidance and insight, and I am thankful for the skills that Steph Brock brought to the project, and for her husband, Brian, whose constant encouragement has been a blessing on me for many years. Thank you also to the folks at Eerdmans, who have been extremely supportive and have encouraged me in times when I felt like finding something else to do! They have become friends, and I am grateful for all that they do. Thanks must also go to Michael Thomson for taking this project on before he moved on to Wipf and Stock. Thank you to Ronald Otto and the folks at Thresholds in Chicago (https://www.thresholds .org) for their help early on in the project. Most importantly, I want to thank the people who gifted me their life stories. This book is about you and for you, and I am thankful and humbled that you have trusted your stories with me. I only hope I have done your gifts justice. Finally, thank you to God for being gracious and kind and for teaching us that there is nothing in the realm of mental health and ill health or anywhere else that can separate us from God’s love. That is the blessing that keeps us all on track.
xi
Introduction: Life in All Its Fullness Living Well with Jesus I have come that they may have life, and have it to the full. —John 10:101
A few years ago, I attended a lecture on the positive relation ships between religion and mental health given by an eminent professor of psychiatry. He opened his lecture with an intriguing, if somewhat disconcerting, statement: “I only have fifteen minutes to see a patient, and I spend the whole of that time looking at the computer screen trying to work out the patient’s blood levels and checking the efficiency of the patient’s meds.” The rest of the lecture was excellent, but I couldn’t get past that opening statement. As a former mental health nurse, I understand the pressures of a busy, understaffed, and often underfunded health-care system. Nevertheless, that the psychiatrist decided to spend all of the paltry fifteen minutes of each patient’s visit looking at a computer screen is telling. A person’s biological functioning is certainly important. If one assumes that mental health experiences can be primarily or even fully understood and explained in biological terms, then scrutinizing a person’s blood levels for chemical imbalances and checking the impact of medication on blood cell count make sense. However, human beings are not simply a conglomerate of chemical interactions. Humans are persons, living beings who have histories, feelings, experiences, and hopes, and who desire to live well. Living well is not determined by the functioning of our biological processes apart from our individual social, interpersonal, and spiritual experiences. Similarly, understanding the biological dimensions of mental health experiences may turn out to be helpful, but it is unlikely to solve problems that emerge from poverty, loneliness, war trauma, and abuse. It is also unlikely to tell us much about 1. Unless otherwise indicated, all biblical quotations come from the New International Version (2011).
1
Introduction what it means to live with and to experience these things scientists describe as “symptoms.” If you don’t know what these symptoms actually mean for an individual, it is difficult to know what you are trying to control and what a “good outcome” might look like. If you have only fifteen minutes with a patient, you don’t need rich, thick experiential descriptions. Thin ones will do just fine. Time is an issue, but the problem of time reflects deeper issues.
Thick Descriptions The purpose of this book is to provide readers with rich, deep, and thick descriptions of the spiritual experiences of Christians living with mental health challenges. It assumes that in order to understand people’s mental health experiences, we need to find time to listen carefully and cannot be bound by assumptions, even those of powerful explanatory frameworks like the Diagnostic and Statistical Manual (DSM). This book is about how Christians living with severe mental health challenges—depression, schizophrenia, and bipolar disorder— experience their faith lives and strive to live life in all its fullness in the presence of sometimes deeply troubling experiences. The book is not about “severe mental illness” understood as a clinical category. Rather, it is about the experiences of unique and valuable disciples of Jesus who seek to live well with unconventional mental health experiences—experiences that some choose to describe as “severe mental illness” but that can also be described in other important ways.
Life in All Its Fullness In John 10:10, Jesus makes an intensely powerful statement: “I have come that they may have life, and have it to the full.” Life in all its fullness is certainly not life without suffering, pain, or disappointment. That much is clear as we reflect on Jesus’s own life. Nor is it a life without joy, hope, and resurrection life in the Spirit. The quest for life in all its fullness is not the basis for a theology of glory—one that minimizes pain and looks past suffering.2 Rather, it is the foundation for a practical theology of the cross that takes seriously the freedom and release that we have gained through the death and resurrection of Jesus at the same time that it recognizes that cadences of the cross still guide the rhythm and the tempo of the day-to-day life of the world. Life in all 2. For a very helpful overview of Luther’s theology of the cross, see Gerhard Forde, On Being a Theologian of the Cross (Grand Rapids: Eerdmans, 1997).
2
Life in All Its Fullness its fullness is life with God—a God who accompanies us on a complex journey within which we live in the startling light of the resurrection but remain intensely aware that Jesus’s cry from the cross, “My God, my God, why have you forsaken me?” still resonates throughout creation. Life in all its fullness is not life without tears but life with the one who dries our tears and moves us onward to fresh pastures.3 Such fullness of life is what I mean when I suggest that this book is about the ways in which Christians with severe mental health challenges can live well and live faithfully even in the most disconcerting storms. Mental health challenges are difficult experiences, but they needn’t prevent us from living well, living faithfully, and loving Jesus.
Understanding Explanation, Cure, and Healing This book does not attempt to explain mental health challenges. It does not address causes directly, although I do clarify the problem of naming causation from both a scientific and a theological point of view. Instead, it intends to help all of us understand the experience of severe mental health challenges in general, and the role of Christian spirituality in particular, in ways that can bring about insight, compassion, empathy, and enduring faithful relationships. Its focus is on listening carefully to the ways people describe their spiritual experiences and trying to make theological and practical sense of lives that have been touched by difficult, troubling, but sometimes also profoundly revelatory challenges. The book is therefore not about curing mental health challenges. It is about healing, understood as the facilitation of understandings and circumstances in which people can live well with Jesus even when the prospect of cure is beyond our current horizons.
“Mental Illness” as a Journey At heart, the book urges us to change our language about and modify our descriptions of mental health challenges in ways that can help all of us live peaceably and faithfully without misrepresentation and stigma. For the ways in which we describe the world determine what we think we see. What we think we see determines how we respond to what we think we see. How we 3. Rev. 21:4: “ ‘He will wipe every tear from their eyes. There will be no more death’ or mourning or crying or pain, for the old order of things has passed away.” Ps. 23:2: “He makes me lie down in green pastures, / he leads me beside quiet waters.”
3
Introduction respond to what we think we see is a measure of our faithfulness. Language and description matter. Richard Arrandale, in his paper “Madness, Language and Theology,” urges us to reconsider the ways in which we talk about the experiences some describe as “mental illness.” He urges us to move beyond the language of illness, the limits of suffering, and the kinds of military metaphors that turn mental health experiences into battles that need to be fought and won. If “mental illness” is a war, then “those who professionally care for us are the allied forces deployed to win this war, and who often seem to do so with no consideration for the casualties. It is often the case that much of the treatment which is given has worse (and sometimes very long lasting) side-effects than the original problem itself.”4 Military metaphors—battling with schizophrenia, wrestling with bipolar disorder, fighting depression—narrow the person’s choice of description and “treatment” and easily preclude the development of “nonviolent” understandings and approaches. Instead, Arrandale urges the adoption of a kinder, gentler, and more generous hermeneutic that allows for forms of language that open up new worlds and new possibilities: If we dwell in the language of the negative and the military there is a serious danger that this will set the agenda for the people the language is used for/ against. If we can learn to dwell in a language which is positive and liberating this may help in shaping that movement beyond enslavement and existential death. Language used in this way can be part of an exorcism of the linguistic demons which “possess” those with mental health problems— language (and thus a world-view) which, in its negative usage, is content to leave people to live in “the tombs” (Mark 5.2) of labelled madness. A more positive and theological language might enable people to break free from the chains and fetters with which they have been bound. Such a language exorcized of negativity and valuejudgements may allow people with mental health problems to be brought back into the kingdom from which they can feel alienated.5
If the church is possessed by linguistic demons that prevent it from talking faithfully about mental health issues, then exorcism is vital in order to ensure its present and future faithfulness. A primary intention of this book is 4. Richard Arrandale, “Madness, Language and Theology,” Theology 102 (May 1, 1999): 195–202. 5. Arrandale, “Madness, Language and Theology,” 197.
4
Life in All Its Fullness to facilitate faithful speech that moves us to faithful action. By developing a phenomenological approach that takes seriously the lived experience of unconventional mental health experiences, the book offers different ways of articulating the issues; different ways of understanding those who bear the weight of diagnoses; and different forms of description that I have seen bring about liberation and healing. Arrandale asks us to consider framing mental health in terms of a journey. A journey is something we embark upon, willingly or otherwise, as we travel from one place to another. Sometimes we choose our journeys; at other times we are forced to go to places we do not want to. Along the way, we meet people and encounter situations—some helpful, some not—each of which changes the direction of our journey. Some change the meaning of the entire journey. Some journeys are easy and the burden light, like a summer hike; others feel like the winter journey of a refugee. Along the way, we may encounter enemies and become lost and confused. Some of these enemies are in our own heads, while others emerge as our perceived strangeness unsettles people and causes them to react with physical or psychological violence. Above all, the journey is surprising for us and for others. We will need maps, guides, friends, communities, equipment, and, for Christians, ultimately the guidance of God’s Spirit if we are to negotiate our mental health journeys faithfully. But properly equipped, guided, supported, and faithfully accompanied, we can survive even the most powerful and disturbing storms. The key thing about a journey is that we are always heading toward somewhere and something, not nowhere and nothing. Destination matters. The destination, like the winter road before us, can be cold and unclear. If it is uncertain or disappears from sight, we find ourselves in a very difficult, lonely, and deeply hopeless situation. But if we know our destination even in the midst of our sense of lostness, then we have hope. And if we can find hope (or if others can hold it for us), then the journey might actually be going somewhere rather than nowhere. Thinking of mental health challenges as a journey reminds us to hold on to the kind of destination we might want to reach. What that journey looks like in the context of severe mental health challenges is what this book is about.
About the Book and Its Language The core of the book emerges from a series of qualitative research interviews that I carried out over a two-year period with Christians living with major 5
Introduction depression, schizophrenia, and bipolar disorder. I chose to focus on these diagnoses not because they are representative of all mental health challenges but because they are generally acknowledged as particularly problematic and also because they raise important theological and practical issues for individuals, church, and society. Through these interviews, I intended the following:
1 to capture some of the complexities of how people actually experi-
ence their mental health instead of how they or others interpret it, given their assumptions of what their diagnosis represents. This is the phenomenological dimension.
2 to gain insight into the ways in which people’s unconventional mental health experiences affect their faith lives and relationships with God. This is the experience of lived theology.
3 to try to make sense of this in terms of the theology and practice of the church. This is theological reflection and revised practice.
Though these three foci formed the basis of our conversations, the richness of our conversations drew us to other interesting and surprising places. As people granted me entry into the intricacies of their mental health experiences, they helped me to recognize and accept profound insights into the ways in which God is present (or sometimes apparently absent) in their mental health experiences. This entry into their interior worlds quickly taught me that their assumed strangeness is not quite as strange as it first appears. People are just people, even in the midst of difficulties. Much has been written on the relationship between spirituality and mental health.6 Much of it assumes that spirituality is a broad and universal concept comprising a personal search for meaning, purpose, hope, value, and, for some people, God.7 Yet my interviews for this book yielded a quite different understanding of spirituality—that it is not a general search for meaning but something quite specific. The interviewees perceived themselves as disciples of Jesus who were desperately trying to cling to him in the midst of complex 6. H. G. Koenig, M. E. McCullough, and D. B. Larson, eds., Handbook of Religion and Health (New York: Oxford University Press, 2001). 7. For a critique of this approach to spirituality, see John Swinton and Stephen Pattison, “Moving beyond Clarity: Towards a Thin, Vague, and Useful Understanding of Spirituality in Nursing Care,” Nursing Philosophy 11 (2010): 226–37.
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Life in All Its Fullness and difficult circumstances. Their question was not simply: “Where can I find meaning in the midst of my brokenness?” but much more specifically, “Where and how can I find Jesus and hold on to God in the midst of this experience?” The question is simple; the answer is much more complex. Some of the people who share their experiences in the following pages find the language of mental illness beneficial and therapeutic and helpful for understanding and future development. Others do not. I believe people should be allowed to name their experiences in the way that is most helpful and pertinent for them. Readers will note that I don’t use the term “mental illness” in this book. This is not because I am in any sense antipsychiatry or don’t believe that people’s suffering is real.8 I know people’s experiences are very real. Yet describing mental health experiences in terms of illness is only one way of naming and responding to such experience, and not necessarily the best way. I use the term “mental health challenges” for two reasons. First, it focuses our attention on what enables us to remain healthy in the midst of psychological distress. While mental health challenges can cause great suffering and distress, it is possible to find hope and faith in the midst of the wildest storms. Second, the shift from illness to challenge offers a positive and forward-facing orientation. Whereas illness reminds us of what is wrong with us and narrows our range of options, challenge sees the situation as potentially constructive and leaves the door open for a variety of perspectives, interpretations, and descriptions. How to enable people to take up those challenges and learn to live life fully is a primary task of what is to come.
8. The term “antipsychiatry” refers to a movement that adopts the view that psychiatry and psychiatric treatments are more damaging than they are helpful. This movement considers psychiatry to be a coercive instrument of oppression based on unequal power relationships that lead to patients being treated for things the antipsychiatrists assume are problems of living rather than illnesses or diseases. Although I will critique psychiatry and also be quite critical of the idea of mental illness, I value psychiatry and consider it to have a legitimate and significant role in caring for people living with mental health challenges. Readers wishing to read more about antipsychiatry should see T. Szasz, “The Myth of Mental Illness,” American Psychologist 15 (1960): 113–18; D. G. Cooper, Psychiatry and Antipsychiatry (London: Tavistock, 1967); P. Rabinow, ed., “Psychiatric Power,” in Ethics, Subjectivity, and Truth, by M. Foucault (New York: New Press, 1997); and Peter Breggin, Toxic Psychiatry (New York: St. Martin’s, 1991).
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